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Digital records show no effect on diabetes care

NEW YORK (Reuters Health) - Electronic health records have been held up as a way to improve medical care, but a new study suggests they are not necessarily making a difference in diabetes treatment.

The study, of 42 physician practices in two U.S. states, found offices that used electronic records actually gave lower-quality diabetes care than those that stuck with old-fashioned paper records.

On the bright side, diabetes management actually improved across all the practices over the course of the study period. But offices using electronic records lagged.

The findings highlight the fact that switching from paper to e-records, alone, is not enough, according to lead researcher Jesse C. Crosson, an assistant professor at the UMDNJ-Robert Wood Johnson Medical School in Somerset, New Jersey.

"Just having these records doesn't mean they're being used in a meaningful way," Crosson said in an interview.

More needs to be done, he said, to help medical practices translate electronic records into better care.

The study, which appears in the Annals of Family Medicine, adds to others showing that digital records do not magically improve medical care on their own.

Electronic records have been part of a push to improve healthcare quality and cut costs. That's because digital records can, among other things, allow doctors, hospitals and other providers to communicate more easily — with the goal of preventing errors and making sure patients get the tests and treatments they need.

Some electronic systems also have "decision support" software that gives doctors tips on how to best treat individual patients.

The U.S. Congress authorized up to $27 billion in government incentives to get doctors and hospitals to switch to "meaningful use" of health information technology. And by 2015, providers will face penalties if they don't switch.

"Meaningful use" means steps like having up-to-date medication lists for each patient, electronically prescribing drugs, and giving patients electronic copies of their health records if they request.

But so far, studies on the impact of electronic records have been mixed.

There's some evidence that going digital may help cut down on unnecessary tests — but that benefit may be limited to larger doctor-hospital networks using the most-advanced electronic systems.

And it's not clear how much of an effect e-records have had on overall quality of care.

For the new study, Crosson's team focused on diabetes care at 42 medical practices in Pennsylvania and New Jersey, 16 of which had switched to electronic records.

They measured patients' quality of care by looking at how many were getting recommended tests, including regular blood sugar, blood pressure and cholesterol checks — and, if necessary, medication to rein in high numbers.

Over a total of three years, the study found, quality of care generally improved.

At the outset, 44 percent of all patients were meeting treatment guidelines, for example. That had improved to 52 percent at the two-year mark.

But offices using paper records actually did a little better. In those practices, 61 percent of diabetes patients were getting recommended tests two years into the study. That figure was 51 percent among practices using electronic records.

It's not clear why the gap existed, according to Crosson.

He said they had no information on the specific features of the electronic systems offices were using. So it's not possible to say whether certain systems or software features are more effective than others.

But Crosson also pointed to the human element: doctors and their staffs need to shift their mindsets, as well as their records systems. "There needs to be a change in the way doctors think about the delivery of care," Crosson said.

That might include having someone on staff who calls patients with chronic conditions, like diabetes, to "check in to see how they are doing," he said.

The study does have limitations, Crosson's team points out. One is that the data were collected between 2004 and 2006 — and the systems used right now in many doctors' offices may be different.

Electronic records are not the only quality-improvement measure that researchers and policymakers are considering. Information from patients' e-records can also be used in so-called "pay-for-performance" plans.

Those plans offer financial incentives to doctors who achieve certain goals that are known to improve patients' health, reduce errors or save money.

Some governments, in Canada and the UK, for example, have tested pay-for-performance plans — as have some doctor-hospital networks in the U.S.

But a study published last month found that an Ontario program seemed to have made no impact on diabetes patients' quality of care.

Another new study, also in the Annals of Family Medicine, points to similar results in the UK. Looking at 29 family practices in London, researchers found that pay-for-performance incentives have had little impact on long-standing racial disparities in diabetes care.

According to the researchers, that all suggests broad policy shifts are, by themselves, insufficient. More "targeted" steps also seem necessary, they say.

For now, Crosson said, people with diabetes — or other chronic conditions — should not assume they are getting top-notch care simply because their doctor's office has gone digital.

"Even if they are using electronic records, things may still be falling through the cracks," Crosson said.

He suggested that people find out what types of tests and treatments are guideline-recommended for their particular health problem. If you have diabetes, one source would be the American Diabetes Association, he said.

Another good source, Crosson noted, is the U.S. Preventive Services Task Force — an expert panel that makes testing recommendations on a variety of health conditions.